wide-complex rhythm
First Glance:
A regular rhythm with wide and bizarre complexes.
Discussion:
This little clip shows a regular rhythm with wide and ugly-looking complexes. I see no hint of P waves. The rate is around 65 bpm. This could be an accelerated idioventricular rhythm, or a sinus (or junctional rhythm) with marked hyperkalemia (depressed P waves, widened QRS’s). The complexes are a little too abnormal to think that they are isolated conduction aberrancy, but I can’t say it’s not possible, and it’s always possible you just don’t see P’s in a certain lead.
Complexes that look like this are always concerning. This strip is actually from a DNR pt, no longer with palpable radial pulses, and this agonal rhythm brady’d down to nothing over the next twenty minutes.
Why is the line so fuzzy? This is electrical artifact. If you count out the fine regular fuzz you’ll find it runs at 50 or 60 Hz, which is line frequency. Artifacts like this are often due to an ungrounded EKG or telemetry machine, power cords lying near or on leads, fluorescent lights, etc. Generally you can find some way to make it go away, as it makes looking for very fine electric findings a little more confusing.
Final Impression?
Wide complex rhythm with bizarre morphology.
Management implications:
Get a 12L. Check labs.
The Take-home Point:
Regular baseline fuzz is generally 50/60 Hz artifact. Bizarre wide complexes require attention.
Two star strip. The meat and potatoes.